Risk factors for urinary tract infections in children aged 0-36months presenting with fever without source and evaluated for risk of serious bacterial infections

J A Williams-Smith; Y Fougère; J-Y Pauchard; S Asner; M Gehri; P A Crisinel

doi:10.1016/j.arcped.2020.07.006

Risk factors for urinary tract infections in children aged 0-36months presenting with fever without source and evaluated for risk of serious bacterial infections

Arch Pediatr. 2020 Oct;27(7):372-379. doi: 10.1016/j.arcped.2020.07.006. Epub 2020 Sep 9.

Authors

J A Williams-Smith¹, Y Fougère², J-Y Pauchard³, S Asner², M Gehri³, P A Crisinel²

Affiliations

¹ Service of Pediatrics, Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, 1000 Lausanne, Switzerland. Electronic address: joanne.ws@bluewin.ch.
² Unit of Pediatric Infectious Diseases and Vaccinology, Department Women-Mother-Child, Lausanne University Hospital and University of Lausanne, 1000 Lausanne, Switzerland.
³ Service of Pediatrics, Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, 1000 Lausanne, Switzerland.

PMID: 32919843
DOI: 10.1016/j.arcped.2020.07.006

Abstract

Background: Children younger than 36 months with fever without a source (FWS) are at risk of serious bacterial infections (SBI). The risk of occult bacteremia (OB) has been greatly reduced in vaccinated children. The aim of this study is to describe the epidemiology of SBI in children with FWS in our setting and to evaluate the performance of our management algorithm.

Methods: We designed a prospective cohort study. We included children aged 0-36 months presenting with FWS in our emergency unit. Demographic and clinical characteristics, investigations, and management procedures were recorded at the time of inclusion. Information on clinical evolution, final diagnosis, and immunization history were obtained after 10 days. Potential predictors of SBI were compared between patients with and without SBI.

Results: Between October 2015 and September 2017, 173 children were recruited, with a median age of 4.4 months (2.1-1). Of these children, 166 (96%) were up to date with their vaccinations. A total of 47 children (27%) had a final diagnosis of SBI, which were all urinary tract infections (UTI). Presence of chills (odds ratio [OR] 5.6, 95% confidence interval [CI] 1.3-24.3), fever for>2 days (OR 29.1, 95% CI 3.5-243.5), and age<9 months (OR: 45.3, 95% CI: 4.9-415.7) were statistically significant predictors of UTI in a multivariate logistic regression. The sensitivity and specificity of our management algorithm were 100% (95% CI: 92.4-100%) and 21.4% (14.6-29.6%), respectively.

Conclusions: In the setting of high vaccination coverage, we only identified SBI related to UTIs. We could not identify any OB. Our management algorithm was able to identify all SBI, but specificity was low. Refined criteria for screening of UTI could slightly increase this.

Keywords: Children; Fever without source; Urinary tract infection.

Publication types

Clinical Trial

MeSH terms

Algorithms
Bacterial Infections / complications*
Bacterial Infections / diagnosis*
Bacterial Infections / epidemiology
Bacterial Infections / therapy
Case-Control Studies
Child, Preschool
Clinical Decision Rules*
Female
Fever of Unknown Origin / etiology*
Follow-Up Studies
Humans
Infant
Infant, Newborn
Logistic Models
Male
Prevalence
Prospective Studies
Risk Assessment
Risk Factors
Sensitivity and Specificity
Severity of Illness Index
Switzerland / epidemiology
Treatment Outcome
Urinary Tract Infections / complications*
Urinary Tract Infections / diagnosis*
Urinary Tract Infections / epidemiology
Urinary Tract Infections / therapy